Top

BMC Public Health

Published in:

Open Access 01-12-2024 | Mood Disorders | Research

The role of frailty in the relationships between social relationships and health outcomes: a longitudinal study

Authors: Fereshteh Mehrabi, François Béland

Published in: BMC Public Health | Issue 1/2024

Abstract

Background

Socially isolated older adults incur increased risks of adverse health outcomes, though the strength of this association is unclear. We examined whether changes in physical frailty moderated the associations between changes in social relationships and changes in health outcomes among older adults.

Methods

This longitudinal study is based on three waves of the FRéLE study among 1643 Canadian community-dwelling older adults aged 65 years and older over 2 years. We performed latent growth curve modelling (LGMs) to assess changes with the assumption of missing not at random, adjusting for time-invariant covariates. We used the latent moderated structural equations (LMS) to test the interactions in LGMs. Social relationships were measured by social participation, social networks, and social support from different social ties. Frailty was assessed using the five components of the phenotype of frailty.

Results

The results revealed that changes in frailty moderated changes in social participation (β = 3.229, 95% CI: 2.212, 4.245), social contact with friends (β = 4.980, 95% CI: 3.285, 6.675), and social support from friends (β = 2.406, 95% CI: 1.894, 2.917), children (β = 2.957, 95% CI: 1.932, 3.982), partner (β = 4.170, 95% CI: 3.036, 5.305) and extended family (β = 6.619, 95% CI: 2.309, 10.923) with changes in cognitive function and depressive symptoms, but not with chronic diseases. These results highlight the beneficial role of social relationships in declining depressive symptoms and improving cognitive health among older adults experiencing increases in frailty.

Conclusions

The findings suggest that changes in social support have a protective and compensatory role in decreasing depressive symptoms and enhancing cognitive health among older adults with increasing frailty. Public health policy and strategies should consider the impact of social support on multiple health outcomes among older adults with increasing frailty. Further experimental studies and interventions are warranted to extend findings on the relationships between social relationships and health outcomes, targeting frail older adults. Future studies may also consider other health-related risk factors that may impact the associations between social relationships and health outcomes among older adults.

Available only for authorised users

Holt-Lunstad J, Robles TF, Sbarra DA. Advancing social connection as a public health priority in the United States. Am Psychol. 2017;72(6):517.PubMedPubMedCentral

Teo RH, Cheng WH, Cheng LJ, Ying L, Tiang S. Global prevalence of social isolation among community-dwelling older adults: A systematic review and meta-analysis. Archives of Gerontology and Geriatrics; 2022. p. 104904.

Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci. 2015;10(2):227–37.PubMed

Evans IE, Martyr A, Collins R, Brayne C, Clare L. Social isolation and cognitive function in later life: a systematic review and meta-analysis. J Alzheimers Dis. 2019;70(s1):S119-SS44.PubMedPubMedCentral

Sakurai R, Kawai H, Suzuki H, Kim H, Watanabe Y, Hirano H, et al. Poor social network, not living alone, is associated with incidence of adverse health outcomes in older adults. J Am Med Dir Assoc. 2019;20(11):1438–43.PubMed

Berkman LF, Krishna A. Social network epidemiology. In: LFKI B, Glymour MM, editors. Social Epidemiology (2 Eds). Oxford University Press; 2014. p. 234–89.

Holt-Lunstad J, Smith TB. Loneliness and social isolation as risk factors for CVD: implications for evidence-based patient care and scientific inquiry. BMJ Publishing Group Ltd and British Cardiovascular Society; 2016. p. 987–9.

Berkman LF, Kawachi I. Social network epidemiology. In: Berkman LF, Kawachi I, Glymour MM, editors. Social epidemiology (2 ed). Oxford University Press; 2014. p. 234–89.

Holt-Lunstad J, Steptoe A. Social isolation: an underappreciated determinant of physical health. Curr Opin Psychol. 2021;43.

10.

Cudjoe TK, Selvakumar S, Chung SE, Latkin CA, Roth DL, Thorpe RJ Jr, et al. Getting under the skin: social isolation and biological markers in the National Health and aging trends study. J Am Geriatr Soc. 2022;70(2):408–14.PubMed

11.

Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol Ser A Biol Med Sci. 2001;56(3):M146-MM57.

12.

Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–62.PubMed

13.

Smith L, Firth J, Grabovac I, Koyanagi A, Veronese N, Stubbs B, et al. The association of grip strength with depressive symptoms and cortisol in hair: a cross-sectional study of older adults. Scand J Med Sci Sports. 2019;29(10):1604–9.PubMed

14.

Yu B, Steptoe A, Chen Y, Jia X. Social isolation, rather than loneliness, is associated with cognitive decline in older adults: the China health and retirement longitudinal study. Psychol Med. 2020;1-8.

15.

Fan L, Wang S, Xue H, Ding Y, Wang J, Tian Y, et al. Social support and mortality in community-dwelling Chinese older adults: the mediating role of frailty. Risk Manag Healthc Policy. 2021;14:1583.PubMedPubMedCentral

16.

Cacioppo JT, Hawkley LC. Social isolation and health, with an emphasis on underlying mechanisms. Perspect Biol Med. 2003;46(3):S39–52.PubMed

17.

Smith KJ, Gavey S, RIddell NE, Kontari P, Victor C. The association between loneliness, social isolation and inflammation: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2020;112:519–41.PubMed

18.

Kojima G, Aoyama R, Tanabe M. Associations between social isolation and physical frailty in older adults: a systematic review and meta-analysis. J Am Med Dir Assoc. 2022;23(11):e3–6.PubMedPubMedCentral

19.

National Academies of Sciences E, Medicine. Social isolation and loneliness in older adults: opportunities for the health care system. National Academies Press; 2020.

20.

Lang P-O, Michel J-P, Zekry D. Frailty syndrome: a transitional state in a dynamic process. Gerontology. 2009;55(5):539–49.PubMed

21.

Strandberg TE, Pitkälä KH. Frailty in elderly people. Lancet. 2007;369(9570):1328–9.PubMed

22.

Davies K, Maharani A, Chandola T, Todd C, Pendleton N. The longitudinal relationship between loneliness, social isolation, and frailty in older adults in England: a prospective analysis. Lancet Healthy Longev. 2021;2(2):e70-ee7.PubMed

23.

Maltby J, Hunt SA, Ohinata A, Palmer E, Conroy S. Frailty and social isolation: comparing the relationship between frailty and unidimensional and multifactorial models of social isolation. J Aging Health. 2020;32(10):1297–308.PubMedPubMedCentral

24.

Pan C, Cao N. Patterns of social isolation and low social support and frailty trajectories among Chinese older adults. J Appl Gerontol. 2023;07334648231194508.

25.

Dent E, Hoogendijk EO. Psychosocial factors modify the association of frailty with adverse outcomes: a prospective study of hospitalised older people. BMC Geriatr. 2014;14(1):108.PubMedPubMedCentral

26.

Kamiya Y, Kenny RA. Does social engagement predict frailty and mortality in the older population? Applied demography and public health in the 21st century. Springer; 2017. p. 69–79.

27.

Zhang X, Sun M, Liu S, Leung CH, Pang L, Popat UR, et al. Risk factors for falls in older patients with cancer. BMJ Support Palliat Care. 2018;8(1):34–7.PubMed

28.

Risbridger S, Walker R, Gray W, Kamaruzzaman S, Ai-Vyrn C, Hairi N, et al. Social Participation’s association with falls and frailty in Malaysia: a cross-sectional study. J Frailty Aging. 2021;11:1–7.

29.

Merchant RA, Liu SG, Lim JY, Fu X, Chan YH. Factors associated with social isolation in community-dwelling older adults: a cross-sectional study. Qual Life Res. 2020;29:2375–81.PubMed

30.

Li C-L, Hsu H-C. Cognitive function and associated factors among older people in Taiwan: age and sex differences. Arch Gerontol Geriatr. 2015;60(1):196–200.MathSciNetPubMed

31.

Hoogendijk EO, Smit AP, van Dam C, Schuster NA, de Breij S, Holwerda TJ, et al. Frailty combined with loneliness or social isolation: an elevated risk for mortality in later life. J Am Geriatr Soc. 2020;68(11):2587–93.PubMedPubMedCentral

32.

Malini FM, Lourenço RA, Lopes CS. Prevalence of fear of falling in older adults, and its associations with clinical, functional and psychosocial factors: the frailty in Brazilian older people-Rio de Janeiro study. Geriatr Gerontol Int. 2016;16(3):336–44.PubMed

33.

Bevilacqua G, Jameson KA, Zhang J, Bloom I, Fuggle NR, Patel HP, et al. Relationships between non-communicable disease, social isolation and frailty in community dwelling adults in later life: findings from the Hertfordshire cohort study. Aging Clin Exp Res. 2021;1-8.

34.

Mehrabi F, Beland F. Effects of social isolation, loneliness and frailty on health outcomes and their possible mediators and moderators in community-dwelling older adults: a scoping review. Arch Gerontol Geriatr. 2020;90:104119.PubMed

35.

Zunzunegui M-V, Koné A, Johri M, Béland F, Wolfson C, Bergman H. Social networks and self-rated health in two French-speaking Canadian community dwelling populations over 65. Soc Sci Med. 2004;58(10):2069–81.PubMed

36.

Béland F, Zunzunegui M-V, Alvarado B, Otero A, Del Ser T. Trajectories of cognitive decline and social relations. J Gerontol Ser B Psychol Sci Soc Sci. 2005;60(6):P320-PP30.

37.

Huntley J, Ostfeld AM, Taylor JO, Wallace RB, Blazer D, Berkman LF, et al. Established populations for epidemiologic studies of the elderly: study design and methodology. Aging Clin Exp Res. 1993;5(1):27–37.

38.

Béland F, Julien D, Bier N, Desrosiers J, Kergoat M-J, Demers L. Association between cognitive function and life-space mobility in older adults: results from the FRéLE longitudinal study. BMC Geriatr. 2018;18(1):227.PubMedPubMedCentral

39.

Provencher V, Béland F, Demers L, Desrosiers J, Bier N, Ávila-Funes JA, et al. Are frailty components associated with disability in specific activities of daily living in community-dwelling older adults? A multicenter Canadian study. Arch Gerontol Geriatr. 2017;73:187–94.PubMed

40.

Statistics Canada. Canadian Community Health Survey (CCHS)-Healthy Aging questionnaire (2008–2009). 2010:117–20.

41.

Ahmed T, Belanger E, Vafaei A, Koné GK, Alvarado B, Béland F, et al. Validation of a social networks and support measurement tool for use in international aging research: the international mobility in aging study. J Cross-Cult Gerontol. 2018;33(1):101–20.PubMed

42.

Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992;30:473–83.PubMed

43.

Washburn RA, Smith KW, Jette AM, Janney CA. The physical activity scale for the elderly (PASE): development and evaluation. J Clin Epidemiol. 1993;46(2):153–62.PubMed

44.

Washburn RA. Assessment of physical activity in older adults. Res Q Exerc Sport. 2000;71(sup2):79–87.PubMed

45.

Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85–94.PubMed

46.

Jones E, Hanly J, Mooney R, Rand L, Spurway P, Eastwood B, et al. Strength and function in the normal and rheumatoid hand. J Rheumatol. 1991;18(9):1313–8.PubMed

47.

Béland F, Julien D, Wolfson C, Bergman H, Gaudreau P, Galand C, et al. Revisiting the hypothesis of syndromic frailty: a cross-sectional study of the structural validity of the frailty phenotype. BMC Geriatr. 2020;20(1):1–13.

48.

Bergman H, Béland F, Karunananthan S, Hummel S, Hogan D, Wolfson C. Developing a working framework for understanding frailty Howard Bergman, MD. Gérontol Soc. 2004;109:15–29.

49.

Gobbens R, Luijkx K, Wijnen-Sponselee MT, Schols J. Towards an integral conceptual model of frailty. J Nutr Health Aging. 2010;14(3):175–81.PubMed

50.

Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–9.PubMed

51.

Groll DL, To T, Bombardier C, Wright JG. The development of a comorbidity index with physical function as the outcome. J Clin Epidemiol. 2005;58(6):595–602.PubMed

52.

Sheikh JI, Yesavage JA. Geriatric depression scale (GDS): recent evidence and development of a shorter version. Clin Gerontol: J Aging Ment Health. 1986;5.

53.

Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function. Jama. 1963;185(12):914–9.PubMed

54.

Béland F, Bergman H, Lebel P, Clarfield AM, Tousignant P, Contandriopoulos A-P, et al. A system of integrated care for older persons with disabilities in Canada: results from a randomized controlled trial. J Gerontol Ser A Biol Med Sci. 2006;61(4):367–73.

55.

Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3_Part_1):179–86.PubMed

56.

Finlayson M, Havens B. Changes over time in long-term care use, ADL and IADL among the oldest-old participants of the aging in Manitoba longitudinal study. Can J Aging/La Revue Canadienne du Vieillissement. 2001;20(2):271–90.

57.

Spector WD, Fleishman JA. Combining activities of daily living with instrumental activities of daily living to measure functional disability. J Gerontol Ser B Psychol Sci Soc Sci. 1998;53(1):S46–57.

58.

Gil-Salcedo A, Dugravot A, Fayosse A, Dumurgier J, Bouillon K, Schnitzler A, et al. Healthy behaviors at age 50 years and frailty at older ages in a 20-year follow-up of the UK Whitehall II cohort: a longitudinal study. PLoS Med. 2020;17(7):e1003147.PubMedPubMedCentral

59.

Kobayashi LC, Steptoe A. Social isolation, loneliness, and health behaviors at older ages: longitudinal cohort study. Ann Behav Med. 2018;52(7):582–93.PubMedPubMedCentral

60.

Muthén LK, Muthen B. Mplus user’s guide: statistical analysis with latent variables, user’s guide. Muthén & Muthén; 2017.

61.

Wen Z, Marsh HW, Hau K-T, Wu Y, Liu H, Morin AJ. Interaction effects in latent growth models: evaluation of alternative estimation approaches. Struct Equ Model Multidiscip J. 2014;21(3):361–74.MathSciNet

62.

Kim M, Hsu H-Y, Kwok O-m, Seo S. The optimal starting model to search for the accurate growth trajectory in latent growth models. Front Psychol. 2018;9:349.PubMedPubMedCentral

63.

Bauer DJ, Curran PJ. Probing interactions in fixed and multilevel regression: inferential and graphical techniques. Multivar Behav Res. 2005;40(3):373–400.

64.

Muthén B, Asparouhov T. Growth mixture modeling: Analysis with non-Gaussian random effects. Longitudinal data analysis; 2008. p. 143165.

65.

Muthén B, Asparouhov T, Hunter AM, Leuchter AF. Growth modeling with nonignorable dropout: alternative analyses of the STAR* D antidepressant trial. Psychol Methods. 2011;16(1):17.PubMedPubMedCentral

66.

Eisenberger NI, Moieni M, Inagaki TK, Muscatell KA, Irwin MR. In sickness and in health: the co-regulation of inflammation and social behavior. Neuropsychopharmacology. 2017;42(1):242–53.PubMed

67.

Whitson HE, Duan-Porter W, Schmader KE, Morey MC, Cohen HJ, Colón-Emeric CS. Physical resilience in older adults: systematic review and development of an emerging construct. J Gerontol A: Biomed Sci Med Sci. 2016;71(4):489–95.

68.

Fiordelli M, Sak G, Guggiari B, Schulz PJ, Petrocchi S. Differentiating objective and subjective dimensions of social isolation and apprasing their relations with physical and mental health in italian older adults. BMC Geriatr. 2020;20(1):1–13.

69.

Noguchi T, Saito M, Aida J, Cable N, Tsuji T, Koyama S, et al. Association between social isolation and depression onset among older adults: a cross-national longitudinal study in England and Japan. BMJ Open. 2021;11(3):e045834.PubMedPubMedCentral

70.

House JS. Social isolation kills, but how and why? Psychosom Med. 2001;63(2):273–4.PubMed

71.

Uno C, Okada K, Matsushita E, Satake S, Kuzuya M. Friendship-related social isolation is a potential risk factor for the transition from robust to prefrailty among healthy older adults: a 1-year follow-up study. Eur Geriatr Med. 2021;12:285–93.PubMed

72.

Uchino B, Ong A, Queen T, Kent de Grey R. Theories of social support in health and aging. In: Handbook of theories of aging (3rd ed). New York, NY: Springer; 2016.

73.

Peek MK, Howrey BT, Ternent RS, Ray LA, Ottenbacher KJ. Social support, stressors, and frailty among older Mexican American adults. J Gerontol B Psychol Sci Soc Sci. 2012;67(6):755–64.PubMedPubMedCentral

74.

Jin Y, Si H, Qiao X, Tian X, Liu X, Xue Q-L, et al. Relationship between frailty and depression among community-dwelling older adults: the mediating and moderating role of social support. Gerontologist. 2020;60(8):1466–75.PubMed

75.

Min J, Ailshire J, Crimmins EM. Social engagement and depressive symptoms: do baseline depression status and type of social activities make a difference? Age Ageing. 2016;45(6):838–43.PubMedPubMedCentral

76.

Ma L, Sun F, Tang Z. Social frailty is associated with physical functioning, cognition, and depression, and predicts mortality. J Nutr Health Aging. 2018;22:989–95.PubMed

77.

Buffel T, Phillipson C, Rémillard-Boilard S. Age-friendly cities and communities: New directions for research and policy. Encyclopedia of Gerontology and Population Aging; Gu, D, Dupre, ME; 2019. p. 1–11.

78.

World Health Organization. World report on ageing and health. World health Organization; 2015. Report No.: 9241565047.

Title: The role of frailty in the relationships between social relationships and health outcomes: a longitudinal study
Authors: Fereshteh Mehrabi
François Béland
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Mood Disorders
Affective Disorder
Published in: BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-024-18111-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The role of frailty in the relationships between social relationships and health outcomes: a longitudinal study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2024

Health literacy of trans and gender diverse individuals –a cross sectional survey in Germany

Prevalence and correlates of sleep disturbance among adolescents in the eastern seaboard of China

Participatory development of an mHealth intervention delivered in general practice to increase physical activity and reduce sedentary behaviour of patients with prediabetes and type 2 diabetes (ENERGISED)

COVID-19 vaccine intentions and attitudes in Black American emerging adults with asthma

Cross-model validation of public health microsimulation models; comparing two models on estimated effects of a weight management intervention

Peer-led lifestyle interventions for the primary prevention of cardiovascular disease in community: a systematic review of randomised controlled trials